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City of Everett 00 65 19 1 <br />SECTION 00 6519 - CERTIFICATE OF COMPLETION FORM <br />CONTRACTOR: BRINK ELECTRIC, LLC <br />ADDRESS: 8223 BROADWAY <br />CITY: EVERETT STATE:WA 98203 <br />PROJECT TITLE: INDUCTIVE CHARGER INSTALLATION at OPERATION BASE <br />PROJECT NO. <br />DATE WORK COMPLETED: <br />FINAL CONTRACT SUM: $ 912,924.30 <br />CONTRACTOR'S CERTIFICATION <br />I, the undersigned, certify and declare, under penalty of perjury under the laws of the State <br />of Washington, that the foregoing is true and correct: I am authorized to sign for the <br />claimant; that In connection with the work performed and, to the best of my knowledge, no <br />loan, gratuity or gift In any form whatsoever has been extended to any employee of the City <br />Everett, nor have I rented or purchased any equipment or materials from any employee of <br />the City of Everett; that the attached final statement is a true and correct statement showing <br />all the monies due the claimant from the City of Everett for work performed and material <br />furnished under this Contract; that I have carefully examined said final statement and <br />understand the same and; that I, on behalf of the claimant, hereby release and forever <br />discharge the City of Everett from any and all claims of whatsoever nature which I or the <br />claimant may have, arising out of the performance of said Contract, which are not set forth <br />in the attached statement. <br />'r <br />DATED at 1,1k-- G(in r , �Uf this Z1, \ day of , 20 1 <br />City, State) <br />X <br />C'NTRACTO <br />SIGNATURE <br />I certify the attached final <br />statement to be true and correct <br />to the best of my k�r owiedge. <br />X <br />ED <br />Project Manager <br />TITLE <br />DEPARTMENT CERTIFICATION <br />APPROVED DATE: ith`� za z� <br />006519-1 <br />CERTIFICATE OF COMPLETION FORM <br />